WEBVTT - Three Eponymous Diseases 0:00:01.320 --> 0:00:04.280 Welcome to Stuff You Missed in History Class, a production 0:00:04.400 --> 0:00:11.000 of iHeartRadio. 0:00:11.920 --> 0:00:14.200 Hello, and welcome to the podcast. I'm Tracy V. 0:00:14.320 --> 0:00:16.160 Wilson, and I'm Holly Frye. 0:00:16.360 --> 0:00:21.439 I am kind of riffing on Holly's beloved theme of 0:00:21.480 --> 0:00:26.279 eponymous foods, but maybe in a less fun direction, which 0:00:26.320 --> 0:00:29.360 is diseases that are named after places. 0:00:29.600 --> 0:00:33.000 I like how you said, maybe like there's someone else 0:00:33.040 --> 0:00:34.280 going Yeah. 0:00:34.200 --> 0:00:37.640 Somebody is excited about learning where disease names came from. 0:00:38.000 --> 0:00:40.000 If you saw the title of today's episode and you 0:00:40.000 --> 0:00:42.720 saw the word eponymous and you were expecting food treats 0:00:42.720 --> 0:00:48.680 and now you're disappointed, I'm very sorry. The word eponymous 0:00:48.880 --> 0:00:51.560 is I think most often used to describe something named 0:00:51.640 --> 0:00:55.200 after a person, but it can also describe something named 0:00:55.200 --> 0:00:58.280 after a place or a thing. And this episode is 0:00:58.360 --> 0:01:01.640 also inspired by an experience I had a few years 0:01:01.680 --> 0:01:05.160 ago when I went to visit family and the big, 0:01:05.200 --> 0:01:08.319 big local news story. While I was there was an 0:01:08.360 --> 0:01:13.399 outbreak of Legionnaire's disease connected to walking past a hot 0:01:13.440 --> 0:01:18.600 tub display at affair. I found all of that horrifying 0:01:18.840 --> 0:01:20.679 from a number of directions, and it made me, then, 0:01:20.800 --> 0:01:23.880 of course, want to do an episode on Legionnaire's disease. 0:01:23.959 --> 0:01:27.400 That's a totally normal response to this whole experience. I 0:01:27.440 --> 0:01:29.399 was not able to work that into a whole episode, 0:01:29.400 --> 0:01:31.760 and it just took me a while to kind of think, hey, 0:01:32.000 --> 0:01:35.679 there's a theme here. We are going to really be 0:01:35.720 --> 0:01:39.240 focused on the outbreak that led to these diseases being 0:01:39.360 --> 0:01:42.119 identified and named, so it won't be like a whole 0:01:43.160 --> 0:01:48.240 history of any of these three diseases. Two of the 0:01:48.280 --> 0:01:51.120 diseases we're talking about today are ones that people can 0:01:51.160 --> 0:01:56.400 contract through incredibly casual exposure, like walking past a hot 0:01:56.400 --> 0:02:00.440 tub display. The third requires a lot more pro longed 0:02:00.640 --> 0:02:03.880 direct contact with somebody who is acutely ill, but it 0:02:03.920 --> 0:02:08.320 can really still spread very rapidly in certain conditions. Although 0:02:08.639 --> 0:02:11.960 there will be some experimentation on animals mentioned in this 0:02:12.000 --> 0:02:16.960 episode and one of the most disgusting human experiments that 0:02:17.000 --> 0:02:20.320 I've ever encountered while working on this show. We're gonna 0:02:20.320 --> 0:02:23.440 talk about that just as delicately as possible, but it 0:02:23.480 --> 0:02:29.360 is gross. So first up, as Tracy alluded to, Legionnaire's disease, 0:02:29.680 --> 0:02:34.560 which is caused by Legionella bacteria. Multiple species of Legionella 0:02:34.600 --> 0:02:38.760 bacteria can cause disease, but most outbreaks are connected to 0:02:38.880 --> 0:02:44.919 Legionella numophila. Legionella numophila can actually cause two different diseases, 0:02:45.400 --> 0:02:50.040 Legionnaire's disease and pontiac fever. Both of these can cause 0:02:50.080 --> 0:02:54.400 flu like respiratory symptoms, but pontiac fever is generally milder 0:02:54.440 --> 0:02:58.360 and typically resolves on its own. Legionnaire's disease, on the 0:02:58.360 --> 0:03:02.720 other hand, can cause pneumonia and lead to hospitalization and death. 0:03:03.520 --> 0:03:07.640 It's not fully understood why the same bacteria causes two 0:03:07.680 --> 0:03:11.760 clinically different syndromes, or why outbreaks tend to cause one 0:03:12.000 --> 0:03:16.040 or the other. Legionnaire's disease is named for the American 0:03:16.120 --> 0:03:19.640 Legion convention that was held at the Bellevue Stratford Hotel 0:03:19.760 --> 0:03:24.200 in Philadelphia, Pennsylvania, in nineteen seventy six. I guess we 0:03:24.200 --> 0:03:27.360 could have a semantic argument about whether a convention is 0:03:27.400 --> 0:03:31.680 a place or not. I think it is, at least temporarily. 0:03:32.520 --> 0:03:35.960 The American Legion is a veterans organization that was chartered 0:03:36.000 --> 0:03:40.400 by Congress in nineteen nineteen, focused on service to veterans 0:03:40.480 --> 0:03:44.680 and to their communities. This nineteen seventy six state meeting 0:03:44.760 --> 0:03:49.240 in Philadelphia also ran alongside the US bi centennial, so 0:03:49.280 --> 0:03:52.520 there were a lot of other celebrations and festivities going 0:03:52.560 --> 0:03:56.480 on as well. The American Legion Convention took place from 0:03:56.560 --> 0:03:59.680 July twenty first through twenty fourth, and then on July 0:03:59.720 --> 0:04:02.720 twenty twenty seven, a retired Air Force captain who had 0:04:02.760 --> 0:04:07.880 attended the convention died of an apparent heart attack. Within days, 0:04:08.040 --> 0:04:12.320 other convention attendees had also died after reporting symptoms that 0:04:12.400 --> 0:04:17.800 included fevers, headaches, chest pain, and chest congestion. On the 0:04:17.880 --> 0:04:23.160 afternoon of Friday, July thirtieth, doctor Ernest Campbell of Bloomsburg, Pennsylvania, 0:04:23.640 --> 0:04:27.960 tried to alert the Pennsylvania State Public Health Department that 0:04:28.080 --> 0:04:31.600 some of his patients had become seriously ill after attending 0:04:31.600 --> 0:04:35.560 the convention, but he was told the office had closed 0:04:35.600 --> 0:04:39.520 for the day. Another doctor tried to report a similar 0:04:39.600 --> 0:04:42.720 pattern of illnesses to the health department on Saturday, which 0:04:42.720 --> 0:04:45.919 of course, was also still closed. By the time the 0:04:46.000 --> 0:04:50.520 office reopened on Monday, eighteen people had already died. 0:04:51.360 --> 0:04:54.720 In addition to this delay in starting an investigation into 0:04:54.720 --> 0:04:57.800 what was going on, there were some specifics that made 0:04:57.800 --> 0:05:00.640 it hard to pinpoint where this illness had come come from. 0:05:01.360 --> 0:05:05.400 Medical staff who saw multiple patients all around Pennsylvania made 0:05:05.400 --> 0:05:09.279 a connection to the convention right away, but there were 0:05:09.320 --> 0:05:11.719 also people who got sick who had not gone to 0:05:11.760 --> 0:05:14.919 the convention or even been inside the hotel where it 0:05:15.000 --> 0:05:18.440 was held. One was a bus driver who had driven 0:05:18.480 --> 0:05:21.880 a marching band to Philadelphia for a parade, who had 0:05:21.920 --> 0:05:25.120 spent almost all of his time in Philadelphia on the bus. 0:05:25.839 --> 0:05:28.880 Another person was local to Philadelphia but had not been 0:05:29.000 --> 0:05:33.240 in the hotel for a while, investigators were classifying this 0:05:33.400 --> 0:05:38.680 as two different diseases, legionnaire's disease for convention attendees and 0:05:38.760 --> 0:05:41.200 broad Street pneumonia for everyone else. 0:05:42.320 --> 0:05:46.560 Health authorities in Pennsylvania, once they had gotten those reports, 0:05:46.800 --> 0:05:50.760 contacted the Centers for Disease Control, and the CDC reported 0:05:50.760 --> 0:05:53.760 on the illness in its Morbidity and Mortality Weekly Report 0:05:53.880 --> 0:05:57.120 on Friday, August sixth, the same week that the illnesses 0:05:57.160 --> 0:06:00.760 had first been reported to the Pennsylvania State Public Health Department. 0:06:01.600 --> 0:06:05.120 According to this report, one hundred and fifty two people 0:06:05.200 --> 0:06:08.880 associated with the convention had become ill between July twenty 0:06:08.920 --> 0:06:12.480 second and August third, with most of those illnesses starting 0:06:12.520 --> 0:06:16.800 between July twenty fifth and thirty first. Twenty two of 0:06:16.800 --> 0:06:19.839 those one hundred and fifty two people had died, but 0:06:19.920 --> 0:06:23.120 there didn't seem to be an increase in respiratory diseases 0:06:23.120 --> 0:06:27.039 in Philadelphia more generally, and the illnesses didn't seem to 0:06:27.080 --> 0:06:30.240 have spread between these patients and their family members or 0:06:30.320 --> 0:06:34.680 other close contacts. The CDC included weekly updates in the 0:06:34.680 --> 0:06:38.960 Morbidity and Mortality Weekly Report until September third, at which 0:06:39.000 --> 0:06:42.799 point the outbreak was over. As of August thirty first, 0:06:42.920 --> 0:06:46.080 nineteen seventy six, there had been one hundred seventy nine 0:06:46.160 --> 0:06:49.680 cases and twenty eight deaths, including one hundred forty eight 0:06:49.720 --> 0:06:52.640 people who had been at the convention and thirty one 0:06:52.640 --> 0:06:55.760 who had not, but those had been either in or 0:06:55.800 --> 0:06:59.240 near the hotel at some point. The disease had been 0:06:59.320 --> 0:07:04.400 particularly lethal in people who had other conditions like heart disease, diabetes, 0:07:04.560 --> 0:07:09.120 or cancer, but this report did not include what had 0:07:09.240 --> 0:07:12.560 caused the outbreak because at that point they did not know. 0:07:13.320 --> 0:07:17.240 The CDC Epidemic Intelligence Service and the Pennsylvania Department of 0:07:17.280 --> 0:07:20.640 Health had carried out what was at the time the 0:07:20.880 --> 0:07:25.920 largest infectious disease investigation in CDC history. They had more 0:07:25.920 --> 0:07:29.720 than one hundred and fifty investigators and medical professionals involved. 0:07:30.240 --> 0:07:34.400 They looked for evidence of viruses and bacteria, heavy metals, 0:07:34.600 --> 0:07:39.440 environmental toxins, and other potential causes, without any success. They 0:07:39.520 --> 0:07:43.880 checked seemingly every surface and potential source of contamination at 0:07:43.920 --> 0:07:47.680 the hotel. Because there was this clear connection to an 0:07:47.680 --> 0:07:51.480 American Legion convention, there were even concerns that it had 0:07:51.520 --> 0:07:55.360 been an intentional poisoning carried out by anti war protesters, 0:07:55.760 --> 0:07:58.800 or maybe some kind of biological attack connected to the 0:07:58.840 --> 0:08:02.880 Cold War. Meanwhile, this outbreak had gotten a lot of 0:08:02.920 --> 0:08:06.200 press coverage. There had been an outbreak of swine flu 0:08:06.280 --> 0:08:09.600 at Fort Dix in New Jersey the previous winter, believed 0:08:09.680 --> 0:08:11.920 to be very similar to the virus that had caused 0:08:11.960 --> 0:08:15.760 the nineteen eighteen flu pandemic. This had led to fears 0:08:15.800 --> 0:08:19.040 of an impending pandemic and a huge emergency effort to 0:08:19.120 --> 0:08:23.720 vaccinate people. Although a pandemic had not developed, and various 0:08:23.760 --> 0:08:26.440 issues with this vaccine rollout had led the press to 0:08:26.480 --> 0:08:30.280 call it a fiasco. This had led to heightened anxieties 0:08:30.280 --> 0:08:35.160 around the idea of contagious illness. Also, this was an 0:08:35.160 --> 0:08:40.200 illness that had disproportionately sickened and killed veterans, a lot 0:08:40.240 --> 0:08:44.600 of them retirees during the celebration of the US bicentennial, 0:08:44.760 --> 0:08:48.360 so the whole thing had additional layers of emotional impact, 0:08:48.559 --> 0:08:51.400 like this is right on the heels of the Vietnam War, 0:08:52.440 --> 0:08:54.400 but a lot of the people that were that were 0:08:54.440 --> 0:08:57.120 sickened and killed had served in like World War Two 0:08:57.440 --> 0:09:00.560 and the Korean War, and people rea guarded them with 0:09:00.640 --> 0:09:04.120 like a slightly different nuance than how people were viewing 0:09:04.120 --> 0:09:06.720 the Vietnam War at the time. The fact that so 0:09:06.800 --> 0:09:11.439 many people died so quickly also made this outbreak particularly terrifying. 0:09:11.760 --> 0:09:16.360 On August sixteenth, nineteen seventy six, Time Newsweek and US 0:09:16.440 --> 0:09:20.120 News and World Report all had cover stories about the outbreak, 0:09:20.360 --> 0:09:22.880 and all three of them used the word killer in 0:09:22.920 --> 0:09:24.199 the headline. 0:09:24.280 --> 0:09:28.000 By Christmas of nineteen seventy six, the Bellevue Stratford Hotel 0:09:28.080 --> 0:09:31.000 had closed in the aftermath of the outbreak, and the 0:09:31.040 --> 0:09:34.920 CDC had faced intense criticism for not figuring out the cause. 0:09:35.760 --> 0:09:40.320 This included CDC microbiologist Joseph McDade, who got a lecture 0:09:40.360 --> 0:09:42.760 about it at a Christmas party from a random man 0:09:42.800 --> 0:09:46.160 that he had never met before. McDade worked in the 0:09:46.240 --> 0:09:48.880 lab but was not a decision maker at the CDC, 0:09:49.559 --> 0:09:52.400 but over the week between Christmas and New Years, he 0:09:52.520 --> 0:09:55.920 started re examining slides from his initial work on the case. 0:09:56.880 --> 0:10:01.120 This research had involved exposing guinea pigs to pttential pathogens, 0:10:01.240 --> 0:10:04.920 and investigators had figured out that there was something in 0:10:05.080 --> 0:10:08.600 patient's lung tissue that could make the guinea pigs sick, 0:10:08.720 --> 0:10:12.240 but which then couldn't be transmitted from one guinea pig 0:10:12.280 --> 0:10:12.880 to another. 0:10:13.600 --> 0:10:15.880 What they hadn't been able to do was to isolate 0:10:15.960 --> 0:10:17.679 and identify this pathogen. 0:10:18.360 --> 0:10:21.520 A few things were working against them here. One is 0:10:21.520 --> 0:10:24.640 that the bacteria involved didn't respond to some of the 0:10:24.679 --> 0:10:28.960 stains being used to prepare the microscope slides. Another was 0:10:28.960 --> 0:10:33.120 how the CDC was focusing its efforts. Microbiologists had been 0:10:33.120 --> 0:10:37.360 trying to rule out specific pathogens using preparations developed to 0:10:37.440 --> 0:10:42.640 grow those particular pathogens. Some of these preparations used antibiotics 0:10:42.679 --> 0:10:47.120 to prevent contamination by other bacteria, but those antibiotics were 0:10:47.120 --> 0:10:51.280 also killing the bacteria that caused the outbreak. When McDade 0:10:51.400 --> 0:10:56.040 did new cultures without those antibiotics, he immediately saw clusters 0:10:56.080 --> 0:11:00.520 of bacteria under his microscope. Some additional steps can confirmed 0:11:00.520 --> 0:11:03.640 that this bacterium had caused the outbreak, and it was 0:11:03.720 --> 0:11:06.520 ultimately named lee Jionella numophila. 0:11:07.360 --> 0:11:10.479 The CDC put out a special issue of the Morbidity 0:11:10.520 --> 0:11:14.840 Immortality Weekly Report on January eighteenth, nineteen seventy seven, to 0:11:15.000 --> 0:11:18.720 announce the discovery of this bacterium, and then a peer 0:11:18.760 --> 0:11:21.640 reviewed paper was published in the New England Journal of 0:11:21.760 --> 0:11:25.840 Medicine in December. McDade was a key part of this, 0:11:25.960 --> 0:11:27.760 but he did not do it all alone. He was 0:11:27.800 --> 0:11:31.120 one of six authors listed on the paper, along with 0:11:31.200 --> 0:11:35.880 the laboratory investigation team. The most likely scenario for how 0:11:35.880 --> 0:11:39.280 this bacterium sickened and killed so many people is that 0:11:39.360 --> 0:11:42.280 it had been growing in the Bellevue Stratford Hotel's air 0:11:42.360 --> 0:11:46.160 conditioning system. When a heat wave moved through Philadelphia in 0:11:46.280 --> 0:11:50.240 July of nineteen seventy six, the air conditioning system started 0:11:50.240 --> 0:11:54.520 working harder, and bacteria laden missed from the cooling towers 0:11:54.880 --> 0:11:57.600 made its way into the hotel and to the street 0:11:57.600 --> 0:12:00.600 and sidewalk below, which is why people who had not 0:12:00.720 --> 0:12:05.040 been in the hotel had also gotten sick. Identifying this 0:12:05.200 --> 0:12:09.720 bacterium also allowed investigators to go back and re examine 0:12:09.840 --> 0:12:14.000 other earlier outbreaks, going back to at least nineteen fifty nine. 0:12:14.720 --> 0:12:17.960 One of these outbreaks had taken place in Pontiac, Michigan, 0:12:18.120 --> 0:12:22.120 in nineteen sixty eight. Ironically, this outbreak took place at 0:12:22.240 --> 0:12:24.880 the health department and more than ninety percent of the 0:12:24.920 --> 0:12:28.520 employees had gotten sick. This included some of the CDC 0:12:28.720 --> 0:12:32.599 investigators who arrived to investigate the outbreak. This was a 0:12:32.679 --> 0:12:36.280 much milder illness, though, and everyone recovered, and that's why 0:12:36.360 --> 0:12:39.720 pontiac fever is given a separate name from Legionnaire's disease. 0:12:40.520 --> 0:12:44.080 These outbreaks led to efforts to better coordinate between the 0:12:44.160 --> 0:12:49.359 CDC and local health authorities and more stringent sanitation standards 0:12:49.360 --> 0:12:53.640 for things like air conditioning systems, swimming pools, and hot tubs. 0:12:54.120 --> 0:12:57.840 But there are still disease outbreaks caused by these bacteria, 0:12:58.000 --> 0:13:00.880 including the one in twenty nineteen at the Mountain State 0:13:00.920 --> 0:13:03.760 Fair in Fletcher, North Carolina that was the one that 0:13:03.800 --> 0:13:08.160 inspired this episode. The final report on that outbreak listed 0:13:08.200 --> 0:13:11.640 one hundred and thirty six cases of Legionnaire's disease with 0:13:11.800 --> 0:13:15.560 ninety six hospitalizations and four deaths, as well as one 0:13:15.640 --> 0:13:20.600 case of pontiac fever. Legionella bacteria occur naturally in soil 0:13:20.720 --> 0:13:24.319 and water. So some cases of Legionnaire's disease and pontiac 0:13:24.360 --> 0:13:27.680 fever have also been traced to things like potting soil. 0:13:28.720 --> 0:13:31.320 Let's take a little sponsor break, and then after that, 0:13:31.360 --> 0:13:33.559 we're going to be talking about an illness that's really 0:13:33.600 --> 0:13:36.160 not for the squeamish, and that also is going to 0:13:36.200 --> 0:13:49.240 include the particularly gross research. Next, we're going to talk 0:13:49.280 --> 0:13:53.080 about something that's not as deadly as Legionnaire's disease, but 0:13:53.120 --> 0:13:57.040 it can still cause serious illnesses and death, especially in 0:13:57.200 --> 0:14:02.560 older people, babies, and people that have other health conditions. However, 0:14:02.600 --> 0:14:07.880 it is miserable. It is neurovirus, also called Norwalk virus, 0:14:07.960 --> 0:14:11.520 and it's probably responsible for more than half of food 0:14:11.520 --> 0:14:17.839 borne illnesses worldwide. Neurovirus causes acute gastroenterritis, which is also 0:14:17.960 --> 0:14:21.880 known as stomach flu, although that is a totally different 0:14:22.080 --> 0:14:28.440 virus from influenza. Neurovirus is a highly infectious RNA virus 0:14:28.480 --> 0:14:31.040 that can live on surfaces for up to two weeks, 0:14:31.080 --> 0:14:34.880 and it's not killed by alcohol based hand sanitizer and 0:14:35.040 --> 0:14:39.240 is resistant to a lot of disinfectants, and that's how 0:14:39.240 --> 0:14:41.640 you wind up with stuff like at least two hundred 0:14:41.640 --> 0:14:45.600 and forty two people getting neurovirus after one player was 0:14:45.680 --> 0:14:48.320 sick court side on the first night of a basketball 0:14:48.320 --> 0:14:53.120 tournament and well meaning attendees did the cleanup without informing 0:14:53.120 --> 0:14:56.760 the custodial staff of what had happened. This virus has 0:14:56.840 --> 0:14:59.880 probably been around for centuries, but the first clear to 0:15:00.000 --> 0:15:02.920 description of the illness was by John Zahorski in nineteen 0:15:02.960 --> 0:15:07.400 twenty nine in a paper titled Hyperemesis higamis, or the 0:15:07.440 --> 0:15:11.520 Winter Vomiting Disease. So Horski was a doctor who described 0:15:11.560 --> 0:15:14.560 a cluster of cases he had seen in Saint Louis. 0:15:15.000 --> 0:15:18.680 He differentiated between respiratory diseases that could also cause gastro 0:15:18.760 --> 0:15:22.600 intestinal symptoms and a disease in which the gastro intestinal 0:15:22.640 --> 0:15:26.240 symptoms were the whole thing. He also noted that this 0:15:26.360 --> 0:15:30.480 disease tended to happen in the winter, although norovirus is 0:15:30.520 --> 0:15:33.600 more common in the colder months, outbreaks can happen at 0:15:33.640 --> 0:15:38.800 any time of the year. Norovirus is named for Norwalk, Ohio, 0:15:39.040 --> 0:15:42.200 where an outbreak struck an elementary school in October of 0:15:42.280 --> 0:15:45.760 nineteen sixty eight. A few people became ill on the 0:15:45.840 --> 0:15:49.040 evening of October twenty ninth, but then a lot more 0:15:49.080 --> 0:15:52.520 people got sick on October thirtieth and thirty first, making 0:15:52.560 --> 0:15:56.480 for a terrible Halloween for all of them. This outbreak 0:15:56.600 --> 0:16:00.400 ultimately sickened half the school that also spread to people's 0:16:00.440 --> 0:16:03.320 family members and their close contacts, with a wave of 0:16:03.400 --> 0:16:07.680 secondary cases from November first through third, and then additional 0:16:07.760 --> 0:16:12.720 illnesses continuing until November seventh. According to the CDC report 0:16:12.760 --> 0:16:15.760 on the outbreak, there were ninety nine primary cases and 0:16:15.840 --> 0:16:20.960 one hundred secondary cases. Everybody recovered, though, and nobody had 0:16:21.000 --> 0:16:22.160 to be hospitalized. 0:16:22.760 --> 0:16:27.320 The CDC investigated this outbreak as well. An obvious possible 0:16:27.360 --> 0:16:30.720 source for an outbreak of gastro intestinal illness is food, 0:16:31.240 --> 0:16:33.760 but students who had brought their lunch from home got 0:16:33.800 --> 0:16:36.160 sick at about the same rate as students who got 0:16:36.160 --> 0:16:40.280 their lunch from the school cafeteria. Tests on the food 0:16:40.280 --> 0:16:42.480 and milk that were still on hand in the cafeteria 0:16:43.000 --> 0:16:45.560 did not show any signs of pathogens. 0:16:46.000 --> 0:16:49.840 Another obvious possibility is water. The school had its own 0:16:49.880 --> 0:16:53.160 well rather than being on a municipal water system, and 0:16:53.240 --> 0:16:57.359 that well was routinely chlorinated. It was checked for coliform 0:16:57.440 --> 0:17:01.600 bacteria that did not reveal anything. A miss but it 0:17:01.640 --> 0:17:04.439 also wasn't enough to totally rule it out as a 0:17:04.480 --> 0:17:08.040 possible source of illness, so the school just used bottled 0:17:08.080 --> 0:17:10.719 water until the well was determined to be safe. 0:17:11.280 --> 0:17:13.920 When the CDC issued a report on this outbreak in 0:17:14.000 --> 0:17:17.680 the Morbidity and Mortality Weekly Report on November twenty third, 0:17:18.320 --> 0:17:22.320 no specific cause had been identified, but the overall conclusion 0:17:22.480 --> 0:17:25.280 was that the primary cases had all come from a 0:17:25.320 --> 0:17:29.119 single source, while the secondary cases had spread from person 0:17:29.160 --> 0:17:33.639 to person starting with those primary cases, and the suspected 0:17:33.720 --> 0:17:35.520 cause was a virus. 0:17:35.880 --> 0:17:39.840 The CDC's write up also reflects some expectations around gender 0:17:40.080 --> 0:17:44.440 and parenting. Quote person to person spread was probably responsible 0:17:44.440 --> 0:17:48.199 for the secondary cases, and consequently one might expect a 0:17:48.280 --> 0:17:52.360 significantly higher attack rate in mothers, who have more intimate 0:17:52.440 --> 0:17:56.320 contact with sick children than in fathers, and a higher 0:17:56.359 --> 0:17:59.600 attack rate in larger families five or more members than 0:17:59.640 --> 0:18:03.240 in small doller families. Although the attack rate in mothers 0:18:03.359 --> 0:18:07.240 thirty seven percent was higher than in father's twenty two percent, 0:18:07.640 --> 0:18:12.560 this difference was not statistically significant. Furthermore, attack rates in 0:18:12.680 --> 0:18:16.879 large and small families were similar. Although researchers could not 0:18:17.119 --> 0:18:20.600 identify the pathogen right away, they did want to confirm 0:18:20.640 --> 0:18:23.399 whether there was an infectious agent at work that was 0:18:23.480 --> 0:18:27.800 shed by sick people and could infect others. This involved 0:18:27.800 --> 0:18:30.120 collecting and preparing what we are just going to call 0:18:30.240 --> 0:18:34.040 the inoculum, which was then given to volunteer test subjects. 0:18:34.920 --> 0:18:37.440 This was not a new idea. The nineteen seventy one 0:18:37.480 --> 0:18:41.320 paper detailing this research cited three prior studies from the 0:18:41.400 --> 0:18:44.719 nineteen forties and fifties that had similarly showed that it 0:18:44.760 --> 0:18:50.639 was possible to transmit non bacterial gastroenteritis this way. Different 0:18:50.760 --> 0:18:54.320 versions of the inoculum were made from samples collected during 0:18:54.480 --> 0:18:59.240 four outbreaks of gastro intestinal illness at the elementary school 0:18:59.320 --> 0:19:03.240 in Norwalco, Ohio, aboard the US Navy ship Shenandoah while 0:19:03.240 --> 0:19:06.320 it was in the Caribbean, and in New Britain, Connecticut, 0:19:06.359 --> 0:19:11.840 and Bethesda, Maryland. The inoculum was presumed to contain something 0:19:12.040 --> 0:19:16.520 non bacterial that was going to cause gastrointestinal illnesses, but 0:19:16.640 --> 0:19:19.880 it also went through a bunch of cultures and safety 0:19:19.920 --> 0:19:22.040 tests to try to make sure that it did not 0:19:22.240 --> 0:19:26.320 contain any other known pathogen that could cause problems or 0:19:26.359 --> 0:19:30.720 other illnesses. Two groups of participants were part of this study. 0:19:31.440 --> 0:19:34.480 Some were men who were incarcerated at the Maryland House 0:19:34.520 --> 0:19:37.600 of Correction in Jessup, Maryland, and others were from the 0:19:37.600 --> 0:19:41.600 Clinical center of the National Institutes of Health. The paper 0:19:41.640 --> 0:19:45.520 detailing this work described all of these participants as volunteers 0:19:45.880 --> 0:19:50.280 who all gave informed consent before participating, but there are 0:19:50.560 --> 0:19:53.720 a lot of caveats around the idea of volunteering for 0:19:53.800 --> 0:19:58.560 medical research in the context of being incarcerated. The Maryland 0:19:58.600 --> 0:20:01.919 House of Correction was also vote notorious for violence and 0:20:01.960 --> 0:20:04.720 harsh treatment of the people incarcerated there. 0:20:05.640 --> 0:20:09.359 Participants were given a complete physical exam, including lots of 0:20:09.560 --> 0:20:12.320 lab work and chest X rays, to confirm that they 0:20:12.320 --> 0:20:16.080 were in good health before being given the inoculum. They 0:20:16.080 --> 0:20:20.000 were also treated with gamma globulin injections to protect them 0:20:20.320 --> 0:20:24.199 in case there was some kind of hepatitis contamination in 0:20:24.320 --> 0:20:27.280 the inoculum that would not have shown up on tests. 0:20:27.880 --> 0:20:31.359 Participants at the prison were isolated in the prison's hospital ward, 0:20:31.680 --> 0:20:34.399 and participants in the clinical center of the nih were 0:20:34.440 --> 0:20:36.240 placed in isolation rooms there. 0:20:36.960 --> 0:20:40.399 The only inoculum that produced illness in this experiment was 0:20:40.400 --> 0:20:43.280 the one that had been prepared from samples collected in 0:20:43.359 --> 0:20:48.000 Norwalk Ohio. Of the three volunteers who received this inoculum, 0:20:48.160 --> 0:20:52.040 two became ill. Then their samples were used to prepare 0:20:52.080 --> 0:20:57.480 additional inoculum, which was administered to additional test subjects. Seven 0:20:57.600 --> 0:21:01.680 of those nine people also became ill. When another round 0:21:01.720 --> 0:21:05.159 of innoculum was prepared from these patients, only one of 0:21:05.200 --> 0:21:07.320 the fore men who received it became ill. 0:21:08.280 --> 0:21:11.280 A paper detailing this research has been described as a 0:21:11.400 --> 0:21:15.760 landmark article in the study of viral gastroenteritis, and it 0:21:15.840 --> 0:21:19.080 created a pretty thorough picture of how this disease could 0:21:19.080 --> 0:21:22.800 spread and what symptoms it could cause, but it still 0:21:23.000 --> 0:21:26.879 was not clear what the actual pathogen was. The paper 0:21:27.000 --> 0:21:30.600 uses the term non bacterial, and some researchers thought the 0:21:30.640 --> 0:21:34.520 illness must be caused by a virus, but others thought 0:21:34.520 --> 0:21:38.360 a virus was unlikely because so many other acute gastro 0:21:38.440 --> 0:21:43.360 intestinal illnesses were caused by known bacteria, including E. Coli 0:21:43.520 --> 0:21:47.440 and salmonilla. The only thing that had been mostly ruled 0:21:47.440 --> 0:21:50.920 out was toxins, because it seemed unlikely that a toxin 0:21:51.119 --> 0:21:56.040 could progressively pass through multiple people's digestive systems to then 0:21:56.200 --> 0:22:01.280 sicken other people. Researchers using immuno electronic roscopy finally got 0:22:01.280 --> 0:22:04.760 a look at a particle measuring twenty seven nanometers in 0:22:04.840 --> 0:22:09.359 samples collected in Norwalk in nineteen seventy two. This made 0:22:09.400 --> 0:22:14.840 neurovirus the first viral gastroenteritis to be conclusively identified, and 0:22:14.880 --> 0:22:17.119 within a few years it was being connected to a 0:22:17.160 --> 0:22:21.080 lot of illnesses. One paper published in nineteen seventy nine 0:22:21.200 --> 0:22:25.000 suggested that a third of the acute gastroenteritis outbreaks that 0:22:25.200 --> 0:22:28.280 didn't have a known cause had likely been caused by 0:22:28.320 --> 0:22:33.520 Norwalk like viruses. Technological developments later in the nineteen seventies 0:22:33.560 --> 0:22:36.760 and into the nineteen eighties allowed researchers to study the 0:22:36.840 --> 0:22:40.399 virus further and some more easily detect and identify it 0:22:40.480 --> 0:22:44.240 in samples during outbreaks, and this also led to efforts 0:22:44.240 --> 0:22:49.360 to identify other viruses that could cause similar illnesses, including rotavirus, 0:22:49.680 --> 0:22:55.399 enteric dentovirus, and astrovirus. Neurovirus's whole genome was sequenced in 0:22:55.440 --> 0:22:58.520 the nineteen nineties, and today it is described as part 0:22:58.520 --> 0:23:03.600 of the Calisaveridae family of viruses. Studying neurovirus continues to 0:23:03.640 --> 0:23:06.600 be challenging, though it's only been within the last few 0:23:06.680 --> 0:23:10.160 years that researchers have found animal species that could potentially 0:23:10.200 --> 0:23:13.920 work as a model for human beings in terms of neurovirus, 0:23:14.119 --> 0:23:17.159 and it has also only been recently that researchers have 0:23:17.200 --> 0:23:21.720 figured out how to cultivate the virus in vitro. These 0:23:21.760 --> 0:23:24.240 are also some of the reasons why there's not yet 0:23:24.280 --> 0:23:28.560 a vaccine for neurovirus. As we said earlier, it can 0:23:28.640 --> 0:23:31.960 be deadly in some people, but for most people it's 0:23:32.040 --> 0:23:36.080 just an extremely unpleasant inconvenience that would be really nice 0:23:36.080 --> 0:23:39.480 to avoid. According to a paper published in the Journal 0:23:39.520 --> 0:23:43.720 of Infectious Diseases in twenty twenty, neurovirus outbreaks in the 0:23:43.880 --> 0:23:48.240 United States costs an estimated seven point six million dollars 0:23:48.280 --> 0:23:51.960 in direct medical costs annually, and then another one hundred 0:23:51.960 --> 0:23:56.399 and sixty five million dollars in loss productivity. Also just 0:23:56.440 --> 0:23:59.280 it's real unpleasant thing to have to go through beyond 0:23:59.320 --> 0:24:03.399 those economic numbers. In addition to all the difficulties in 0:24:03.440 --> 0:24:06.760 studying the virus itself, there are also multiple strains of 0:24:06.760 --> 0:24:09.679 it that shift very rapidly, and that makes the effort 0:24:09.720 --> 0:24:11.920 to create a vaccine even more complicated. 0:24:12.480 --> 0:24:16.000 So there are going to continue to be neurovirus outbreaks 0:24:16.080 --> 0:24:20.040 all around the world for the foreseeable future. They're particularly 0:24:20.119 --> 0:24:25.960 common in places like hospitals, schools, and restaurants. Gastro Intestinal illnesses, 0:24:25.960 --> 0:24:29.520 including neurovirus, are so common on cruise ships that the 0:24:29.560 --> 0:24:33.600 Centers for Disease Control has a whole vessel sanitation program 0:24:33.880 --> 0:24:37.720 to try to prevent and track outbreaks on board. Some 0:24:37.760 --> 0:24:41.200 outbreaks are almost counterintuitive, like there have been a number 0:24:41.200 --> 0:24:44.600 of outbreaks on long distance hiking trails like the Pacific 0:24:44.720 --> 0:24:48.320 Crest Trail and the Appalachian Trail, which are exacerbated by 0:24:48.320 --> 0:24:52.240 people using common latrines and shelters and often relying on 0:24:52.359 --> 0:24:56.840 hand sanitizer rather than soap and water. Let's take a 0:24:56.880 --> 0:24:59.360 quick sponsor break and then talk about on illness that's 0:24:59.359 --> 0:25:02.800 a lot dead than neurovirus, but also not nearly as 0:25:02.840 --> 0:25:03.680 easy to spread. 0:25:13.600 --> 0:25:16.040 The last disease we're going to talk about is one 0:25:16.040 --> 0:25:19.560 that is surrounded by a lot of stigma and fear, 0:25:20.000 --> 0:25:24.439 which is ebola virus disease. Ebolavirus disease is a hemorrhagic 0:25:24.600 --> 0:25:28.600 disease with a high mortality rate. The World Health Organization 0:25:28.960 --> 0:25:33.520 estimates the average at fifty percent, although different species of 0:25:33.760 --> 0:25:37.280 ebolavirus can have very different mortality rates, some of them 0:25:37.400 --> 0:25:41.880 much higher than that. People who survive ebola infection can 0:25:41.960 --> 0:25:46.119 also have long term physical and mental health effects afterward. 0:25:46.960 --> 0:25:50.560 All of this is genuinely scary, which has really contributed 0:25:50.640 --> 0:25:53.880